Lower respiratory tract infection (LRTI) is the most lethal infection remains among patients undergoing treatment for cancer. Most of the previous studies with cancer patients have focus on blood stream infections. For that reason the aim of our study was to examine the spectrum and recent trends in antimicrobial resistance of Gram negative bacteria (GNB) recovered from cancer patient having LRTI in Egypt. In addition our objective was to investigate the prevalence and distribution of Legionella pneumophila among cancer patients with LRTI. Sputum specimens were collected from 285 cancer patients suspecting of having LRTI. The conventional methods and Microscan Negative Identification panel Type 2 were used for identification of GNB. Susceptibility was assessed for 20 antibiotics in bacterial isolates using agar diffusion method. All the sputum specimens were tested by culture and genus specific PCR for the detection of Legionella pneumophila. A total of 130 GNB were isolated. Among these, Klebsiella pneumoniae was the most common (35.4 %). We isolated and identified a number of less frequent GNB (17%), whereas no Legionella pneumophila was detected. Amikacin was found to be the most effective antimicrobial against GNB. We reported very high percentage of multi-drug resistance GNB (96%). This study reported the development of multidrug resistance Gram negative bacilli in Egypt. Continuous updating of data on antimicrobial susceptibility proﬁles is required to ensure the efﬁcacy of antimicrobial agents against GNB due to continuous development of antimicrobial resistance patterns among these pathogens.